Epidemiology of Blindness From Facial Trauma: A Multi-Centre Nigerian Study

Study Design This is a multi-centre retrospective study. Objective To determine the prevalence of blindness and pattern of facial trauma associated with blindness among Nigerians. Methods A multi-centre retrospective study of all patients with facial trauma resulting in blindness, that were co-managed by maxillofacial surgeons and ophthalmologists in 4 Nigerian public tertiary hospitals between January 2010 and December 2019 was undertaken. Data was analysed by IBM SPSS Statistics (version 21.0 for windows, IBM© Inc, Chicago, IL). Results Of 2070 patients who presented with major facial injuries during the study period, 61 eyes of 56 (2.7%) patients were blind. Blindness was bilateral and unilateral in 5 (8.9%) and 51 (92.1%) patients, respectively. The mean age (SD) at presentation was 36.2 (16.6) years, and 47 (83.9%) of these patients were males. Road traffic accident (n = 27; 48%) was the commonest mechanism of facial trauma, the cheek (n = 18; 40.9%) was the commonest site of associated soft tissue injury and zygomatic complex fracture (n = 19; 24.1%) was the commonest related fracture. Globe rupture (n = 34; 55.7%) was the leading cause of blindness. Enucleation (n = 7; 13.2%) and evisceration (n = 22; 41.5%) were performed on 29 eyes of which 12 (41.4%) patients had ocular prosthesis post-operatively. Conclusion Blindness was recorded in 2.7% of Nigerians with facial trauma. The commonest mechanism of trauma and cause of blindness in at least one eye were road traffic accident and globe rupture, respectively. Eye removal surgery was necessary in about half of the blind eyes.

Comparison of Shiraz Trauma Transfusion Score (STTS) Potency With Common Scoring Systems for Trauma in Predicting the Short and Long Term Mortality of Injured Patients

Background and Objective: Trauma is the leading cause of death in people under 40 years of age worldwide. Various studies have been conducted focused on reducing the annual mortality rate due to trauma. One of the most important measures is reducing the time between the incident and the treatment set up, therefore the estimation of the severity of trauma and progressing to mortality before further evaluation is justified. In this study, we aim to compare different trauma scoring systems (such as GAP, MGAP, RTS, TRISS) with a relatively new model – Shiraz Trauma Transfusion Score (STTS) – and to describe the best qualities of these scoring systems for trauma patients in short (less than 24 hours) and long (more than 24 hours) term.Methods: In this cross-sectional study, data from hospitalized trauma patients in Rajaei hospital (center B) of Shiraz, Iran from May to November 2016 were collected and analyzed. Collected data consisted of age, sex, hospital admission duration, mechanism of trauma along with clinical data for calculating different trauma scoring systems, were recorded. Results: while RTS and STTS were the best predictors of mortality in trauma patients in the first 24 hours (sensitivity of 100.00%), GAP and MGAP were the best predictors of the patients’ survival (specificity of 93.83% and 92.59%). GAP and ISS were the best predictors of mortality in trauma patients for more than 24 hours (sensitivity of 82.02%). On the other hand, TRIS and RTS were the best predictors of patients' survival (specificity of 82.59% and 80.26%).Conclusions: Our study findings suggest that the utility and applicability of Shiraz Trauma Transfusion Score(STTS) in predicting mortality is not only comparable with other commonly used scoring methods but it may be of more value in shortterm mortality prediction.

Comparison of Shiraz Trauma Transfusion Score (STTS) Potency With Common Scoring Systems for Trauma in Predicting the Short and Long Term Mortality of Injured Patients

Background and Objective: Trauma is the leading cause of death in people under 40 years of age worldwide. Various studies have been conducted focused on reducing the annual mortality rate due to trauma. One of the most important measures is reducing the time between the incident and the treatment set up, therefore the estimation of the severity of trauma and progressing to mortality before further evaluation is justified. In this study, we aim to compare different trauma scoring systems (such as GAP, MGAP, RTS, TRISS) with a relatively new model – Shiraz Trauma Transfusion Score (STTS) – and to describe the best qualities of these scoring systems for trauma patients in short (less than 24 hours) and long (more than 24 hours) term.Methods: In this cross-sectional study, data from hospitalized trauma patients in Rajaei hospital (center B) of Shiraz, Iran from May to November 2016 were collected and analyzed. Collected data consisted of age, sex, hospital admission duration, mechanism of trauma along with clinical data for calculating different trauma scoring systems, were recorded. Results: while RTS and STTS were the best predictors of mortality in trauma patients in the first 24 hours (sensitivity of 100.00%), GAP and MGAP were the best predictors of the patients’ survival (specificity of 93.83% and 92.59%). GAP and ISS were the best predictors of mortality in trauma patients for more than 24 hours (sensitivity of 82.02%). On the other hand, TRIS and RTS were the best predictors of patients' survival (specificity of 82.59% and 80.26%).Conclusions: Our study findings suggest that the utility and applicability of Shiraz Trauma Transfusion Score(STTS) in predicting mortality is not only comparable with other commonly used scoring methods but it may be of more value in shortterm mortality prediction.

Trauma, alcohol and drugs misuse in car and motorcycle drivers: a prevalence study in a level one trauma center

Alcohol and drugs misuse represents an important social problem. There is no agreement about influence of ethanol and drugs on trauma severity and clinical course. The aim of this study was to investigate the impact of alcohol and drugs abuse on road related trauma managed to our Level I Trauma Center. Data of 1067 car or motorcycle drivers consecutively admitted in a 5 years period were retrospectively analyzed. The sample was divided into two groups: patients with alcohol and/or drugs misuse and patients without detectable plasmatic levels or not screened because no clinical suspicion of these substance. Demographic data, mechanism of trauma, severity of injury, daily and season time of trauma distribution, alcohol and drugs levels and outcomes were retrieved. Alcohol or drugs misuse were detected in 242 patients. Heavy alcohols levels were the 62.3%. Among drugs cannabis was the most detected substance. These patients were significantly younger than the overall study population (p = 0.011), with a higher ISS (p = 0.012) a lower RTS (p = 0.047), a lower GCS (p = 0.005) and an higher head injuries severity (p = 0.030). Regarding time distribution, Saturday was the day with the highest percentage of trauma associated with substance misuse (21%). Alcohol/drugs misuse plays a very important role in the epidemiology of road related trauma. Despite the higher severity of trauma scores and the higher incidence of severe head injuries in patients with alcohol or drugs consumption, there were no effects of this substances on mortality of injured patients involved in road crashes.

Replantation fingertip without venous anastomoses in children

Objective. Traumatic complete and partial finger amputations are rare in comparison with adults. There are significant differences between mechanism of trauma, principles of treatment children with this type of injury in comparison with adults.Clinical case. A 15-years old child suffered from injury by axe, which caused the traumatic fingertip amputation of III and IV digits of his right hand. Replantation of both amputated parts was performed. Arteries and nerves were repaired with no veins anastomosed. As a result - survival of replanted parts.Discussion. A submillimeter diameter of vessels and potential venous congestion are basic problems that a surgeon deal with when perform the replantation of fingertips. Respectively, a difficulty in post-operative care of patient appears.Conclusion. Replantation of amputated part of finger is a golden standard of treatment of children with a described type of injury. The correct deliverance of amputated parts, the shortest time of ischemia as possible, a qualitive operation and post-operative care play an important role in successful survival of the replanted segments.

Eight-year analysis of bullfighting injuries in Spain, Portugal and southern France

Improving knowledge on the epidemiology and analysing the prognostic factors of severity for injuries caused by fighting bulls in Spain, Portugal and southern France. Observational retrospective study including 1239 patients with a reported history of bull horn injuries between January 2012 and November 2019 in Spain, Portugal or southern France. A multiple logistic regression test was used to analyse the prognostic factors of severity and mortality rate of these lesions. The mean accident rate was 9.13% and the mortality rate was 0.48%. The most frequent mechanism of trauma was goring, and the commonest locations of the lesions were thigh and groin. Vascular lesion was found in 20% of thigh/groin gorings. Prognostic factors of severity were vascular lesion, head trauma, fracture, goring injuries and age of the animal. The most reliable prognostic factors of mortality were vascular lesion and goring in the back. Lesions caused by fighting bulls are common in the bullfighting events held in Spain, Portugal and southern France. Although the mortality rate is low, there is a higher morbidity rate, which is conditioned by vascular lesion. All medical teams should include a surgeon experienced in vascular surgery and an anaesthesiologist.

Risk Factors of Trauma-induced Thrombotic Microangiopathy-like Syndrome: A Retrospective Analysis

Background: Patients with trauma may develop thrombocytopenia. We encountered cases wherein patients experienced symptoms resembling thrombotic microangiopathies (TMAs) following severe trauma. As the condition of these patients did not comply with the diagnostic criteria of thrombotic thrombocytopenic purpura and there is no mention of trauma among the several causes of TMAs, it was termed as “trauma-induced thrombotic microangiopathy-like syndrome” (t-TMAS). In this study, we aimed to analyze risk factors that may affect the incidence of t-TMAS in patients with severe trauma. Methods: This retrospective study was conducted in the trauma intensive care unit at the Kyungpook National University Hospital between January 2018 and December 2019. The medical records 1164 of the 1392 enrolled participants were analyzed. To assess risk factors of t-TMAS, we analyzed age, sex, mechanism of trauma, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), hematologic examination, and red blood cell (RBC) volume transfused in 24 h. Results: Among 1164 patients, 20 (1.7%) were diagnosed with t-TMAS. The univariate analysis revealed higher age, ISS, and myoglobin, lactate, creatine kinase-myocardial band (on admission), creatine phosphokinase, lactate dehydrogenase (LDH), and lactate (day 2) levels in the t-TMAS group than in the non-t-TMAS group. The RBC volume transfused in 24 h was higher in the t-TMAS group than in the non-t-TMAS group. t-TMAS was more common in patients with injuries in the chest, abdomen, and pelvis (AIS score ≥3) than in those with head injuries (AIS score ≥3) alone. The higher the sum of AIS scores of the chest, abdomen, and pelvis injuries, the higher the incidence of t-TMAS. Multivariate analysis revealed age, ISS, and LDH level (day 2) to be independent predictors of t-TMAS.Conclusions: Trauma surgeons should consider the possibility of t-TMAS if thrombocytopenia persists without any evidence of bleeding, particularly among older patients with multiple severe torso injuries who have high LDH levels on day 2. Early diagnosis and treatment of t-TMAS could improve patients’ prognosis.

Lunate dislocations: anatomy, diagnosis and management

Lunate dislocation is an uncommon but serious wrist injury, often resulting from a high energy mechanism of trauma. Advanced trauma life support protocols should be followed to diagnose and treat concomitant life-threatening pathology. Thorough neurovascular and soft tissue examination is required to identify open wounds and median nerve dysfunction, including acute onset carpal tunnel syndrome. Imaging is undertaken to appreciate injury severity, which is graded by the Mayfield classification. Closed reduction in the emergency department is the initial management, which alleviates pressure on neurovascular structures. Definitive management is surgical, most commonly via open reduction and direct ligamentous stabilisation. The aims of surgery are to restore anatomical carpal alignment and maintain stability, allowing repair and healing of the important wrist ligaments. Medium-to long-term functional outcomes are adequate, with most patients returning to work within 6 months. However, progressive radiographic midcarpal arthrosis is common, as well as permanent loss of grip strength, range of motion and chronic pain. This article considers the anatomy, diagnosis and management of acute lunate and perilunate dislocations.

Blunt gastric rupture: a plural clinical presentation and literature review

Blunt trauma is still the leading mechanism of trauma found in patients admitted to trauma centres worldwide. In these patients, the gastric injury is a very rare lesion, occurring in less than 2% of all blunt traumas. Besides the low incidence, gastric rupture mortality is high, which makes the diagnosis an essential step. Thus, this study aims to report two blunt gastric injuries, with different clinical features, prompting the discussion about the main features of clinical suspicion and diagnosis, besides the main therapeutic approaches. Therefore, this study can alert the medical community to the quick diagnosis and assertive therapy, saving patients of unwelcome endpoints.